| NPI | 1265738942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP8840) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AZ RN157120) |
| Enumeration Date | 2011-01-28 |
| Last Update Date | 2024-09-26 |